Your Personal Guide to Breast Augmentation

1. Your Personal Guide to Breast Augmentation 858-455-0290 | WWW.RSINGERMD.COM

2. Considering a breast augmentation? Having a breast augmentation is an important decision. Have you always been interested in increasing the size of your breasts, but weren’t sure where to start? That’s why we’re here. We created this guide to provide you with all the information you need to know about breast augmentation: How To Choose a Plastic Surgeon, Breast Implant Sizes and Types, Breast Incision Placement, Risks, Recovery and more. We’re here to help you through this life-changing journey. 858-455-0290 | WWW.RSINGERMD.COM

3. Who are we? Dr. Robert Singer has helped thousands of people in Southern California and around the world attain the rejuvenated appearance they have always wanted. Dr. Singer has been engaged in private practice in the La Jolla area of San Diego since 1976 and is now an internationally recognized plastic surgeon. Board Certified Plastic Surgeon (American Board of Plastic Surgery) in La Jolla, San Diego, California. Dr. Singer appears regularly on radio and television programs such as Larry King Live, in national and local newspapers, and in national and international fashion, news, and health magazines. Dr. Singer has also been a resource for plastic surgery information to the Medical Board of California and the Congress of the United States. Dr. Singer is a sought-after speaker who lectures to prominent surgical organizations and non-medical audiences in the United States, Europe, Asia, and Central America, including the prestigious Young Presidents’ Organization, CEO, and World Presidents Organization. Throughout his career, Dr. Singer has also authored many scientific publications on various aspects of reconstructive and aesthetic plastic surgery. We want to ensure the best education and support for anyone interested in plastic surgery. We aim for each patient to experience excellence. 858-455-0290 | WWW.RSINGERMD.COM

4. What is breast augmentation? Those who benefit from breast augmentation (enlargement) surgery are typically women with breasts that are small, unequal in size, or sagging due to age, as well as women whose breasts are markedly smaller after pregnancy. When the breasts are re-contoured and enlarged with an implant, women often experience a renewed sense of their own femininity and a substantial increase in their self-confidence. Breast implants are small pliable rubber silicone shells which are filled with sterile salt-water solution (saline) or silicone-gel. Ideally, breast augmentation surgery, also called augmentation mammoplasty, lasts for a lifetime. No one, however, can guarantee the life cycle of an implant or how the breasts normally change with age, so it may not be a one time surgery. Other breast-sculpturing procedures can be performed in conjunction with breast augmentation. These include breast lift, reduction of large aureole (colored area around the nipples), correction of inverted nipples, enlargement of small nipples, and reduction of overly prominent nipples. Younger women will be pleased to know that since the implant is placed behind their own breast tissue, or behind the muscle in back of the breast tissue, the nipples may still function and allow for nursing. 858-455-0290 | WWW.RSINGERMD.COM

5. How do I choose the right implant size? It depends on multiple factors: Individual anatomy, existing breast volume, breast dimensions of height, width and projection, ribcage width, chest shape, tissue thickness, desired outcome, and realistic expectations. There is no standardization of cup size. A 32 C and a 36 C are very different. Cup sizes vary from bra manufacturer to bra manufacturer. Even different styles from a manufacturer will vary in what they label a cup size. The best way to choose an implant size is to try on try on sizers in the office while wearing a tight t-shirt, bathing suit or sports bra. The best implant is individualized. There are advantages and disadvantages of each type of implant. Both are utilized by surgeons across the country with satisfactory results. They are both approved for usage by the FDA. The best way to determine what the best implant is for you is to discuss the advantages and disadvantages of the various types of implants along with your concerns and personal preferences at a consultation 858-455-0290 | WWW.RSINGERMD.COM

6. How to Choose Your Plastic Surgeon • The most crucial factor in achieving the results you desire is selecting the best plastic surgeon for your breast augmentation. Don’t feel pressured in your decision-making process; instead, take your time to make an educated choice. Before every consultation, do your own research and look into the surgeon’s training and experience. Being well-informed will ensure your comfort and confidence throughout the entire process and your procedure. • What to research and verify about your surgeon: • Plastic surgery specialty • Plastic surgery board-certification by the American Board of Plastic Surgery (ABPS) • Ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS) • Years of experience and training • Hospital privileges for the breast procedure that will be performed in any facility • Surgical facility/office accreditation by a nationally recognized organization such as: • American Association for Accreditation of Ambulatory Surgery Facilities. (AAAASF) • State licensure as a surgical facility 858-455-0290 | WWW.RSINGERMD.COM

7. Plastic Surgery Certification • There are several ways to find a qualified plastic surgeon. You can begin with referrals from friends or family members who’ve had breast augmentations. You can also look up plastic surgeons in your area, and on their website, you can read testimonials from their past patients. • Additionally, you can contact any of the following highly respected professional organizations: • American Board of Plastic Surgery (ABPS) • American Society for Aesthetic Plastic Surgery (ASAPS) • The American Society of Plastic Surgeons (ASPS) • American College of Surgeons • International Society of Aesthetic Plastic Surgeons (ISAPS) 858-455-0290 | WWW.RSINGERMD.COM

8. Does the doctor adhere to a strict code of ethics? • Has he fulfilled continuing education requirements, including patient-safety techniques? • What percentage of the doctor’s practice is cosmetic versus reconstructive plastic surgery? • How long has the doctor been performing the procedures you are considering? • Does the doctor have hospital privileges to perform the procedures you are considering? • Can you receive a copy of the doctor’s professional biography that summarizes his training?qualifications and credentials? • Does the office provide, at the consultation, an itemized “fee quotation sheet,” listing all proposed services and charges? • Who will administer the anesthetic- an anesthesiologist (physician specialist), or will it be a nurse, a nurse anesthetist, or the surgeon? • Is the surgery performed entirely by your surgeon? Or is a part-delegated surgeon-in-training or associate? • Will the operating surgeon and the staff perform all of the postoperative care? • Is the outpatient surgical facility located in a medical building or immediately adjacent to a major hospital? • Is the surgical facility accredited by AAAASF? Questions for Your Plastic Surgeon Asking questions during your initial consultation will help you better assess your plastic surgeon in order for you to feel at ease with him or her throughout the process. Your surgeon should listen well and answer your questions in a patient, respectful manner. After you research your surgeon, you may want to find out more about him or her as well as the facility that the procedure would take place. 858-455-0290 | WWW.RSINGERMD.COM

9. After you are confident about your choice of surgeon, it is always necessary to ask additional questions during your initial consultation about your procedure. The following are common breast augmentation questions that many women have when considering the procedure: • What are the potential risks and complications associated with getting breast implants? • Is it possible that I may need additional breast procedures after an augmentation? • What would my breasts look like if I eventually chose to have the implants removed but not replaced? • What shape, size, surface texturing, incision site and placement site do you recommend for my body? • Will my ability to breastfeed be affected? • How can I expect my breasts to look as I age? • How can I expect my breasts to look after pregnancy or after breastfeeding? • What are my options if I am dissatisfied with the result of my breast augmentation? • Can I see before and after pictures for each procedure, and which results do you believe are realistic for my body? Key Questions About Breast Augmentation 858-455-0290 | WWW.RSINGERMD.COM

10. The Breast Augmentation Procedure From consultation to recovery, we are dedicated to ensuring that you experience excellence by communicating with you every step of the way. We want you to understand the process, so you will have realistic expectations of how long the procedure takes, what is involved during surgery, how to approach recovery, and potential risks. Remember the importance of asking your plastic surgeon questions about the procedure as well as understanding the process before you decide. 858-455-0290 | WWW.RSINGERMD.COM

11. Are breast implants safe? Breast implants are among the most tested of medical devices. No other medical device has been studied to the extent that breast implants have. Extensive studies of tens of thousands of women with breast implants have shown that both saline and silicone implants are safe. They do not produce a higher rate of cancer or autoimmune disease. After vigorous evaluation by the FDA, both are approved for cosmetic and reconstructive usage. 858-455-0290 | WWW.RSINGERMD.COM

12. Breast Augmentation Surgery • Step 1: Anesthesia • In the past few decades, sophisticated monitoring techniques and new highly refined medications have combined to make general anesthesia very safe, and recovery from it is smoother and faster than previously. General anesthesia uses anesthetic gases as well as intravenous medicines, and often involves a breathing tube (placed after you are asleep). • Step 2: Incisions • Our office performs breast augmentation with two different incision locations: • Periareolar (under the nipple) – scar blends well, but there is a slightly higher risk of difficulty breast-feeding, and larger implants cannot be placed • Inframammary (bottom of breast) – scar will be easily concealed, there is a lower risk of difficulty breast feeding and possibly a slightly lower risk of capsular contraction 858-455-0290 | WWW.RSINGERMD.COM

13. Breast Augmentation Surgery Step 3: Placement of the Implant The placement of implants can be either submuscular (partially under the pectoralis muscle), subglandular (over the muscle and under the breast tissue), or today’s most common placement called “dual-plane” (combination of submuscular and subglandular). Our goal is to provide optimal longevity of your implants and to avoid deformities that cannot be corrected, which include visible implant edges and rippling. The ideal placement in any particular patient depends on their particular anatomy and understanding of the pros and cons of each approach. Your concerns should be discussed at the consultation. • SUBGLANDULAR • Not recommended for thin tissues • More visible and palpable implants • Higher risk of capsular contracture • More difficult mammograms • SUBMUSCULAR • Appropriate for thin tissues • Less visible and palpable implants • Lower risk of capsular contracture • Less difficult mammograms • DUAL-PLANE • Less visible and palpable implants • Lower risk of capsular contracture • Less tendency to ride high on chest wall • Higher tendency for bottoming out 858-455-0290 | WWW.RSINGERMD.COM

14. Breast Augmentation Surgery Step 4: Following the Procedure Immediately following the procedure, small pieces of tape are placed over the incisions. If desired, a soft bra without an underwire can be worn the next day. Swelling will subdue within one month, and the breasts will reveal their final shape and size within six months. You should not be working for three to four days. After surgery, light physical activity, such as walking, is permitted and encouraged. However, heavy exercise, lifting and sexual activity should be avoided for three weeks. Chest exercises should wait until at least six weeks after your procedure. 858-455-0290 | WWW.RSINGERMD.COM

15. Breast Augmentation Recovery After surgery, pain and discomfort can be easily relieved with prescribed medication and usually subsides in a matter of days. The greatest period of discomfort usually lasts about twenty four to forty eight hours. Thereafter, you should have less discomfort and less need for medication. Occasionally, it lasts a little longer. Implants placed in the submuscular position initially produce more discomfort than those placed in front of the muscle. You should “take it easy” the day of your operation and the following days. Increase your activity as instructed. Depending on the kind of work you do, you may return to your job as soon as you are comfortable. If your work is fairly sedentary, you may go back to work in three to four days after surgery. Do not lift anything over ten pounds for three weeks. Exercise can typically be resumed three to four weeks following breast enlargement surgery. Strenuous sports such as golf, tennis, swimming, bowling, jogging, aerobics, jazzercise, or bicycling may be resumed after three weeks with a “sport” bra for support. Refrain from any activity, which significantly raises your body temperature, and/or blood pressure for three weeks after surgery. This includes hot tubbing, sexual relations, and brisk walking. You may notice some swelling, tightness and numbness, but these are all normal and temporary. If you notice sudden swelling in specifically one of your breasts, severe pain, redness, drainage or a fever, please contact the office immediately. It is important to follow your surgeon’s pre and post-operative instructions. 858-455-0290 | WWW.RSINGERMD.COM

16. RecoveryTimeline • 1st Week • You are allowed to shower the day after surgery. • Light activity, including walking, is permitted and encouraged immediately following surgery. • You may be able to return to work 3-4 days after surgery, depending on the nature of your job. • You should not lift, pull or push anything that causes pain and limit strenuous activity for 3 weeks. • You will need to set up an appointment with your surgeon to check on your recovery process. • 2nd and 3rd Weeks • You should minimize excessive physical or sexual activity for at least 3 weeks after surgery. • Most swelling will resolve within 1 month. • Long-term • Return to your surgeon’s office for follow-ups at the recommended times and if you notice any changes in your breasts. • Contact your plastic surgeon with any questions or concerns. 858-455-0290 | WWW.RSINGERMD.COM

17. PotentialRisks • Every surgery comes with specific benefits as well as risks. Below are several of the potential risks of breast augmentation surgery: • Rupture– A breast implant may rupture at any time after surgery, but this is more likely to happen after 10 years. MRI screening is recommended by the FDA for silicone implants at 3 years after your initial surgery and every 2 years thereafter in order to check for a silent rupture. If a rupture is found, removal with or without replacement is recommended. • Capsular contracture– Capsular contracture is the tightening of the internal scar tissue around an implant. This may result in firmness or hardness of the breast as well as discomfort. Additional surgery may be required if these symptoms are severe. • Infection– Most infections, which are rare, occur within several days following the procedure, but they are still possible at any time. If an infection requires removal, replacement may not be feasible until 3 months later. • Hematoma/Seroma – A hematoma is a collection of blood in the area surrounding the implant. A seroma is a pocket of clear fluid that can develop in the body after surgery. Both can result in an infection or capsular contracture. While small collections may resolve on their own, larger amounts of fluid or blood require additional surgery and incisions. • Mammography– Breast implants may make mammography more difficult. Techniques have been developed to adequately visualize the breast tissue. You should alert your mammography center that you have breast implants, and you should continue to perform monthly self-examination of your breasts. 858-455-0290 | WWW.RSINGERMD.COM

18. Before & After View Before & After images of real patients who have had Breast Augmentation surgery with Dr. Robert Singer to see examples of excellent breast augmentation results. Before and After images are a great way to help visualize what your breast augmentation results can be like. Search through our library for more Before and After images to help you visualize your breast augmentation results. Dr. Robert Singer’s Breast Augmentation Before and After Images 858-455-0290 | WWW.RSINGERMD.COM

19. Helpful Resources • To help get you started on your journey through research, surgery, and recovery, view the helpful resources below. These resources can help connect you to those in the community who have also had breast augmentation, information on breast augmentation, and common questions answered about breast augmentation. • American Society for Aesthetic Plastic Surgery • American Society of Plastic Surgeons • Dr. Singer’s Breast Augmentation FAQ • NewBeauty • RealSelf • Smart Beauty Guide 858-455-0290 | WWW.RSINGERMD.COM